Inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return-to-work: causal mediation analyses of a randomized controlled trial

Lene Aasdahl; Tom Ivar Lund Nilsen; Paul Jarle Mork; Marius Steiro Fimland; Eivind Schjelderup Skarpsno

doi:10.2340/jrm.v56.18385

Inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return-to-work: causal mediation analyses of a randomized controlled trial

J Rehabil Med. 2024 Jan 12:56:jrm18385. doi: 10.2340/jrm.v56.18385.

Authors

Lene Aasdahl¹, Tom Ivar Lund Nilsen², Paul Jarle Mork³, Marius Steiro Fimland⁴, Eivind Schjelderup Skarpsno⁵

Affiliations

¹ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Unicare Helsefort Rehabilitation Centre, Rissa, Norway. lene.aasdahl@ntnu.no.
² Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Anaesthesia and Intensive Care, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
³ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
⁴ Unicare Helsefort Rehabilitation Centre, Rissa, Norway; Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁵ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway.

Abstract

Objective: Studies suggest that symptom reduction is not necessary for improved return-to-work after occupational rehabilitation programmes. This secondary analysis of a randomized controlled trial examined whether pain intensity and mental distress mediate the effect of an inpatient programme on sustainable return-to-work.

Methods: The randomized controlled trial compared inpatient multimodal occupational rehabilitation (n = 82) with outpatient acceptance and commitment therapy (n = 79) in patients sick-listed due to musculoskeletal and mental health complaints. Pain and mental distress were measured at the end of each programme, and patients were followed up on sick-leave for 12 months. Cox regression with an inverse odds weighted approach was used to assess causal mediation.

Results: The total effect on return-to-work was in favour of the inpatient programme compared with the control (hazard ratio (HR) 1.96; 95% confidence interval (95% CI) 1.15-3.35). There was no evidence of mediation by pain intensity (indirect effect HR, 0.98; 95% CI, 0.61-1.57, direct effect HR, 2.00; 95% CI, 1.02-3.90), but mental distress had a weak suppression effect (indirect effect HR, 0.89; 95% CI, 0.59-1.36, direct effect HR, 2.19; 95% CI, 1.13-4.26).

Conclusion: These data suggest that symptom reduction is not necessary for sustainable return-to-work after an inpatient multimodal occupational rehabilitation intervention.

Publication types

Randomized Controlled Trial

MeSH terms

Acceptance and Commitment Therapy*
Humans
Inpatients
Mediation Analysis
Mental Disorders* / rehabilitation
Pain Measurement
Return to Work
Sick Leave

Grants and funding

The study was funded by the Research Council of Norway and allocated government funding through the Central Norway Regional Health Authority. The funders had no role in the design of the project and collection, analysis, interpretation of data, writing the manuscript and in publication decisions.